Current Issue

The Korean Journal of Cognitve & Biological Psychology - Vol. 34 , No. 2

[ Original Article ]
The Korean Journal of Cognitve & Biological Psychology - Vol. 34, No. 2, pp. 67-81
Abbreviation: KCBPA
ISSN: 1226-9654 (Print)
Print publication date 30 Apr 2022
Received 18 Aug 2021 Revised 07 Feb 2022 Accepted 13 Feb 2022

성인 ADHD와 우울한 성인의 인지통제 결함: 순행성 통제와 반응성 통제 요구도에 따른 AX-CPT 수행 비교
김인용1 ; 박태원2 ; 김호영1,
1전북대학교 심리학과
2전북대학교 의과대학 정신건강의학교실

Exploring the cognitive control deficits in adults with ADHD and adults with depression: the AX-CPT performance under different proactive and reactive control demands
Inyong Kim1 ; Tae Won Park2 ; Hoyoung Kim1,
1Department of Psychology, Jeonbuk National University
2Department of Psychiatry, Jeonbuk National University Medical School
Correspondence to : 김호영, 전북대학교 심리학과, (54896), 전라북도 전주시 덕진구 백제대로 567, E-mail:

ⓒ The Korean Society for Cognitive and Biological Psychology
Funding Information ▼


본 연구에서는 순행성 통제(proactive control)와 반응성 통제(reactive control)로 구분되는 기제를 통해 인지통제가 작동한다는 인지통제의 이중기제(Dual Mechanism of Control, DMC) 이론의 관점에서 성인 ADHD의 인지통제 결함의 특성을 탐색하였다. 이를 위해 성인 ADHD 27명, 정상 대조군 성인 29명이 본 연구에 참여하였으며, 성인 ADHD에서 흔히 동반되는 우울이 인지통제에 미치는 영향을 알아보기 위해 ADHD가 아닌 우울한 성인 17명도 참여하였다. 인지통제 과제로 사용된 AX-CPT는 4가지 유형의 단서-탐색자극 쌍(AX, AY, BX, BY)으로 구성되며, AX에는 표적 반응을 나머지 자극 쌍에는 비표적 반응을 하게 하는 연속수행과제이다. 본 연구에서는 표적 반응에 대응하는 단서-탐색자극 쌍인 AX의 비율(AX-40 vs. AX-70)로 순행성 통제의 요구도를, 탐색자극 대신에 반응을 억제해야 하는 nogo 자극이 제시되는 nogo 시행을 이용(기저 vs. nogo 조건)하여 반응성 통제의 요구도를 조작하였다. AX-비율 조건은 역균형화하였으며, AX-비율 조건 내에서 기저 조건, nogo 조건 순으로 실시되었다. 성인 ADHD 집단은 단서를 이용하여 반응을 사전에 준비하는 순행성 통제과정이 전반적으로 저하된 데 비해, 우울 집단은 강력히 편향된 반응을 순행적으로 억제해야 조건(AX-70의 BX)에서만 낮은 수행을 보였다. 또한 반응성 통제에 대한 요구도가 높은 nogo 시행에서는 ADHD 집단과 우울 집단 모두 정상 집단에 비해 낮은 수행을 보였다. 이러한 결과는 성인 ADHD가 순행성 통제와 반응성 통제를 포함한 전반적인 인지통제의 결함을 가짐을 시사하며, 반응성 통제 결함은 이차적 우울의 영향도 혼재되었을 가능성을 시사한다.


This study aimed to explore the characteristics of cognitive control deficits in adult ADHD from the perspective of Dual Mechanism of Control (DMC), which posits that cognitive control operates via two distinct dimensions, i.e., proactive and reactive control. AX-CPT, including nogo trials, was utilized to tap cognitive control processes in a sample of 27 adults with ADHD, 17 adults with depression, and 29 healthy adults. The performance of adults with ADHD was compared to that of adults with depression as well as healthy adults to investigate the effects of depression, which is a common comorbid condition in adult ADHD. AX-CPT is a continuous performance test consisting of four types of cue-probe pairs (AX, AY, BX, BY) and requires participants to respond to a probe based on a preceding cue. AX pairs are target pairs matched with a target response, and other pairs are non-target pairs matched with a non-target response. The proactive control demands were manipulated with the proportion of AX trials(AX-40 vs. AX-70) and the reactive control demands were manipulated with nogo trials(base vs. nogo). The order of the two AX-proportion conditions were counterbalanced, and the base condition and the nogo condition were implemented in order within each AX-proportion condition. The adult ADHD group showed lower accuracy than the depression group and the healthy control group in the performance of BX trials that require proactive inhibitory control. Both the ADHD group and the depression group performed lower than the healthy control group in nogo trials that require reactive inhibitory control. These results suggest that adults with ADHD have a deficit in overall cognitive control, including proactive and reactive control, and the reactive control deficit of adult ADHD may be associated with comorbid depression as well as ADHD itself.

Keywords: dual mechanisms of control, proactive control, reactive control, AX-CPT, adult ADHD
키워드: 인지통제의 이중기제 이론, 순행성 통제, 반응성 통제, 성인 ADHD


이 논문은 2019년도 전북대학교 연구교수 연구비 지원과 정부(과학기술정보통신부)의 재원으로 한국연구재단의 지원을 받아 수행된 연구임(No.2019R1G1A1005936).

1. Advokat, C., Martino, L., Hill, B. D., & Gouvier, W. (2007). Continuous Performance Test (CPT) of college students with ADHD, psychiatric disorders, cognitive deficits, or no diagnosis. Journal of Attention Disorders, 10(3), 253-256.
2. Alderson, R. M., Kasper, L. J., Hudec, K. L., & Patros, C. H. (2013). Attention-deficit/hyperactivity disorder (ADHD) and working memory in adults: A meta-analytic review. Neuropsychology, 27(3), 287-302.
3. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders Fifth edition. American Psychiatric Association.
4. Antshel, K. M., Hier, B. O., & Barkley, R. A. (2014). Executive functioning theory and ADHD. In Goldstein, S., & Naglieri, J. A. (Eds.), Handbook of Executive Functioning (pp. 107-120). NY: Springer.
5. Armengol, C. G. (2003). Effect of comorbid depression on continuous performance test (CPT) tasks in college students with attention deficit hyperactivity disorder (ADHD). Revista Espanola de Neuropsicologia, 5(1), 33-48.
6. Banich, M. T., Burgess, G. C., Depue, B. E., Ruzic, L., Bidwell, L. C., Hitt-Laustsen, S., Du, Y. P., & Willcutt, E. G. (2009). The neural basis of sustained and transient attentional control in young adults with ADHD. Neuropsychologia, 47(14), 3095-3104.
7. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65-94.
8. Barkley, R. A., & Murphy, K. R. (2006). Attention-deficit hyperactivity disorder: A clinical workbook: Guilford Press.
9. Boonstra, A. M., Oosterlaan, J., Sergeant, J. A., & Buitelaar, J. K. (2005). Executive functioning in adult ADHD: A meta-analytic review. Psychological Medicine, 35(8), 1097-1108.
10. Braver, T. S., Barch, D. M., & Cohen, J. D. (1999). Cognition and control in schizophrenia: A computational model of dopamine and prefrontal function. Biological Psychiatry, 46(3), 312-328.
11. Braver, T. S., Gray, J. R., & Burgess, G. C. (2007). Explaining the many varieties of working memory variation: Dual mechanisms of cognitive control. In Conway, A. R. A., Jarrold, C., Kane M. J., Miyake, A., & Towse, J. N. (Eds.), Variation in Working Memory, (p. 76-106). Oxford University Press.
12. Braver, T. S. (2012). The variable nature of cognitive control: A dual mechanisms framework. Trends in Cognitive Sciences, 16(2), 106-113.
13. Bredemeier, K., Warren, S. L., Berenbaum, H., Miller, G. A., & Heller, W. (2016). Executive function deficits associated with current and past major depressive symptoms. Journal of Affective Disorders, 204, 226-233.
14. Burgess, G. C., Depue, B. E., Ruzic, L., Willcutt, E. G., Du, Y. P., & Banich, M. T. (2010). Attentional control activation relates to working memory in attention-deficit/hyperactivity disorder. Biological Psychiatry, 67(7), 632-640.
15. Bush, G., Valera, E. M., & Seidman, L. J. (2005). Functional neuroimaging of attention-deficit/hyperactivity disorder: A review and suggested future directions. Biological Psychiatry, 57(11), 1273-1284.
16. Canivez, G. L., & Watkins, M. W. (2010). Investigation of the factor structure of the wechsler adult intelligence scale-fourth edition (WAIS-IV): Exploratory and higher order factor analyses. Psychological Assessment, 22(4), 827.
17. Caye, A., Rocha, T. B. M., Anselmi, L., Murray, J., Menezes, A. M., Barros, F. C., Goncalve, H., Wehrmeister, F., Jensen, C. M., Steinhause, H., C., & Swanson, J. M. (2016). Attention-deficit/hyperactivity disorder trajectories from childhood to young adulthood: Evidence from a birth cohort supporting a late-onset syndrome. JAMA Psychiatry, 73(7), 705-712.
18. Cho, M. J., & Kim, K. H. (1993). Diagnostic validity of the CES-D (Korean version) in the assessment of DSM-III-R major depression. Journal of Korean Neuropsychiatric Association, 32(3), 381-399.
19. Chon, K. K., Choi, S. J., & Yang, B. C. (2001). Integrated adaptation of CES-D in Korea. Korean Journal of Health Psychology, 6(1), 59-76.
20. Cooper, S. R., Gonthier, C., Barch, D. M., & Braver, T. S. (2017). The role of psychometrics in individual differences research in cognition: A case study of the AX-CPT. Frontiers in Psychology, 8, Article 1482.
21. Dhar, M., Been, P. H., Minderaa, R. B., & Althaus, M. (2010). Information processing differences and similarities in adults with dyslexia and adults with attention deficit hyperactivity disorder during a continuous performance test: A study of cortical potentials. Neuropsychologia, 48(10), 3045-3056.
22. Fischer, A. G., Bau, C. H., Grevet, E. H., Salgado, C. A., Victor, M. M., Kalil, K. L., ... & Belmonte-de-Abreu, P. (2007). The role of comorbid major depressive disorder in the clinical presentation of adult ADHD. Journal of Psychiatric Research, 41(12), 991-996.
23. Fried, R., Surman, C., Hammerness, P., Petty, C., Faraone, S., Hyder, L., ... & Biederman, J. (2012). A controlled study of a simulated workplace laboratory for adults with attention deficit hyperactivity disorder. Psychiatry Research, 200(2-3), 949-956.
24. Gonthier, C., Macnamara, B. N., Chow, M., Conway, A. R., & Braver, T. S. (2016). Inducing proactive control shifts in the AX-CPT. Frontiers in Psychology, 7, Article 1822.
25. Grane, V. A., Brunner, J. F., Endestad, T., Aasen, I. E. S., Kropotov, J., Knight, R. T., & Solbakk, A. K. (2016). ERP correlates of proactive and reactive cognitive control in treatment-naive adult ADHD. PLoS One, 11(7), e0159833.
26. Gratton, G., Cooper, P., Fabiani, M., Carter, C. S., & Karayanidis, F. (2018). Dynamics of cognitive control: Theoretical bases, paradigms, and a view for the future. Psychophysiology, 55(3), e13016.
27. Harvey, P. O., Fossati, P., Pochon, J. B., Levy, R., LeBastard, G., Lehéricy, S., Allilaire, J. F., & Dubois, B. (2005). Cognitive control and brain resources in major depression: An fMRI study using the n-back task. Neuroimage, 26(3), 860-869.
28. Heo, S., Kim, J. H., Joung, Y. S., Lee, W. I., Kim, J. J., Sohn, S. H., & Chang, S. A. (2018). Clinical utility of the Korean version of the WHO adult attention-deficit/hyperactivity disorder self-report scale screener. Psychiatry Investigation, 15(3), 325-329.
29. Holmes, A. J., MacDonald III, A., Carter, C. S., Barch, D. M., Stenger, V. A., & Cohen, J. D. (2005). Prefrontal functioning during context processing in schizophrenia and major depression: an event-related fMRI study. Schizophrenia Research, 76(2-3), 199-206.
30. Holmes, A. J., & Pizzagalli, D. A. (2007). Task feedback effects on conflict monitoring and executive control: Relationship to subclinical measures of depression. Emotion, 7(1), 68-76.
31. Holmes, A. J., & Pizzagalli, D. A. (2008). Response conflict and frontocingulate dysfunction in unmedicated participants with major depression. Neuropsychologia, 46(12), 2904-2913.
32. Hwang, S. T., Kim, J. H., Park, K. B., Chey, J. Y., & Hong, S. H. (2012). Korean wechsler adult intelligence scale-IV; K-WAIS-IV. Daegu: Korea Psychology Research Institute.
33. Iselin, A. M. R., & DeCoster, J. (2009). Reactive and proactive control in incarcerated and community adolescents and young adults. Cognitive Development, 24(2), 192-206.
34. Jolles, D., & Crone, E. A. (2012). Training the developing brain: A neurocognitive perspective. Frontiers in Human Neuroscience, 6, Article 76.
35. Joormann, J., & Tanovic, E. (2015). Cognitive vulnerability to depression: Examining cognitive control and emotion regulation. Current Opinion in Psychology, 4, 86-92.
36. Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., & Spencer, T. (2005). The World Health Organization adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245-256.
37. Kim, E. J. (2003). The validation of Korean adult ADHD Scale(K-AADHDS). Korean Journal of Clinical Psychology, 22(4), 897-911.
38. Kim, J. H., Lee, E. H., & Joung, Y. S. (2013). The WHO adult ADHD self-report scale: Reliability and validity of the Korean version. Psychiatry Investigation, 10(1), 41-46. Retrieved from
39. Kim, S. Y., Jang, M. S., Seo, W. S., & Bae, D. S. (2009). The difference of executive function in ADHD children with and without depression. Journal of the Korean Society of Biological Therapies in Psychiatry, 15(1), 21-28.
40. King, J. A., Colla, M., Brass, M., Heuser, I., & von Cramon, D. Y. (2007). Inefficient cognitive control in adult ADHD: Evidence from trial-by-trial stroop test and cued task switching performance. Behavioral and Brain Functions, 3(1), 1-19.
41. Larochette, A. C., Harrison, A. G., Rosenblum, Y., & Bowie, C. R. (2011). Additive neurocognitive deficits in adults with attention-deficit/hyperactivity disorder and depressive symptoms. Archives of Clinical Neuropsychology, 26(5), 385-395.
42. Lee, J. W. (2019). Korean domestic trends of research and direction for adult ADHD. The Journal of Developmental Disabilities, 23(3), 1-23.
43. Lee, S. M., Choi, J. W., Kim, K. M., Kim, J. W., … , & Kim, B. N. (2016). The Guideline of diagnosis and treatment of attention-deficit hyperactivity disorder: Developed by ADHD translational research center. Journal of the Korean Academy of Child & Adolescent Psychiatry, 27(4), 236-266.
44. Lopez-Garcia, P., Lesh, T. A., Salo, T., Barch, D. M., MacDonald, A. W., Gold, J. M., Daniel, R., Milton, S., Steven, M. S,& Carter, C. S. (2016). The neural circuitry supporting goal maintenance during cognitive control: A comparison of expectancy AX-CPT and dot probe expectancy paradigms. Cognitive, Affective, & Behavioral Neuroscience, 16(1), 164-175.
45. Mackie, M. A., Van Dam, N. T., & Fan, J. (2013). Cognitive control and attentional functions. Brain and Cognition, 82(3), 301-312.
46. McIntosh, D., Kutcher, S., Binder, C., Levitt, A., Fallu, A., & Rosenbluth, M. (2009). Adult ADHD and comorbid depression: A consensus-derived diagnostic algorithm for ADHD. Neuropsychiatric Disease and Treatment, 5, 137-150.
47. Mueller, A., Hong, D. S., Shepard, S., & Moore, T. (2017). Linking ADHD to the neural circuitry of attention. Trends in Cognitive Sciences, 21(6), 474-488.
48. Neely, K. A., Wang, P., Chennavasin, A. P., Samimy, S., Tucker, J., Merida, A., ... & Huang-Pollock, C. (2017). Deficits in inhibitory force control in young adults with ADHD. Neuropsychologia, 99, 172-178.
49. Owens, E. B., Zalecki, C., Gillette, P., & Hinshaw, S. P. (2017). Girls with childhood ADHD as adults: Cross-domain outcomes by diagnostic persistence. Journal of Consulting and Clinical Psychology, 85(7), 723.
50. Paucke, M., Stibbe, T., Huang, J., & Strauss, M. (2019). Differentiation of ADHD and depression based on cognitive performance. Journal of Attention Disorders, 1087054719865780. Advance online publication.
51. Paulus, M. P. (2015). Cognitive control in depression and anxiety: Out of control?. Current Opinion in Behavioral Sciences, 1, 113-120.
52. Ramsay, J. R., & Rostain, A. L. (2015). Cognitive behavioral therapy for adult ADHD: An integrative psychosocial and medical approach second edition. Routledge.
53. Redick, T. S. (2014). Cognitive control in context: Working memory capacity and proactive control. Acta Psychologica, 145, 1-9.
54. Schneider, W., Eschman, A., & Zuccolotto, A. (2002). E-Prime (Version 2.0). [Computer software and manual]. Pittsburgh, PA Psychology Software Tools Inc.
55. Schulz, K. P., Li, X., Clerkin, S. M., Fan, J., Berwid, O. G., Newcorn, J. H., & Halperin, J. M. (2017). Prefrontal and parietal correlates of cognitive control related to the adult outcome of attention-deficit/hyperactivity disorder diagnosed in childhood. Cortex, 90, 1-11.
56. Sergeant, J. A., Geurts, H., Huijbregts, S., Scheres, A., & Oosterlaan, J. (2003). The top and the bottom of ADHD: A neuropsychological perspective. Neuroscience & Biobehavioral Reviews, 27(7), 583-592.
57. Sidlauskaite, J., Dhar, M., Sonuga-Barke, E., & Wiersema, J. R. (2020). Altered proactive control in adults with ADHD: Evidence from event-related potentials during cued task switching. Neuropsychologia, 138, 107330.
58. Sobanski, E. (2006). Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience, 256(1), i26-i31.
59. Solanto, M. V., Marks, D. J., Wasserstein, J., Mitchell, K., Abikoff, H., Alvir, J. M. J., & Kofman, M. D. (2010). Efficacy of meta-cognitive therapy for adult ADHD. American Journal of Psychiatry, 167(8), 958-968.
60. Stordal, K. I., Lundervold, A. J., Egeland, J., Mykletun, A., Asbjørnsen, A., Landrø, N. I., ... & Lund, A. (2004). Impairment across executive functions in recurrent major depression. Nordic Journal of Psychiatry, 58(1), 41-47.
61. Van Ameringen, M., Mancini, C., Simpson, W., & Patterson, B. (2011). Adult attention deficit hyperactivity disorder in an anxiety disorders population. CNS Neuroscience & Therapeutics, 17(4), 221-226.
62. van Dijk, F., Schellekens, A., van den Broek, P., Kan, C., Verkes, R. J., & Buitelaar, J. (2014). Do cognitive measures of response inhibition differentiate between attention deficit/hyperactivity disorder and borderline personality disorder?. Psychiatry Research, 215(3), 733-739.
63. Vanderhasselt, M. A., De Raedt, R., De Paepe, A., Aarts, K., Otte, G., Van Dorpe, J., & Pourtois, G. (2014). Abnormal proactive and reactive cognitive control during conflict processing in major depression. Journal of Abnormal Psychology, 123(1), 68-80.
64. West, R., Choi, P., & Travers, S. (2010). The influence of negative affect on the neural correlates of cognitive control. International Journal of Psychophysiology, 76(2), 107-117.
65. White, H. A. (2007). Inhibitory control of proactive interference in adults with ADHD. Journal of Attention Disorders, 11(2), 141-149.
66. Yoo, S. W., Kim, Y. S., Noh, J. S., Oh, K. S., Kim, C. H., …, & Oh, D. J. (2006). Validity of Korean version of the mini-international neuropsychiatric interview. Anxiety and Mood, 2(1), 50-55.
67. Zeeuw, P. D., & Durston, S. (2017). Cognitive control in attention deficit hyperactivity disorder. In T. Egner (Ed.), The Wiley handbook of cognitive control (p. 602-618). Wiley-Blackwell.
68. Zhang, H., Kang, C., Wu, Y., Ma, F., & Guo, T. (2015). Improving proactive control with training on language switching in bilinguals. NeuroReport, 26(6), 354-359.